The present invention relates to medication administration systems. More specifically, the present invention relates to medication administration systems in a medical facility.
Automated medication dispensing systems have been in use for many years. The initial purpose of such systems was to reduce the high rates of medication errors associated with manual distribution and the high cost of maintaining a large amount of inventory. The literature indicates that medication errors occur in the following areas: 13% at prescribing, 42% at administering, 27% at documentation, 17% at dispensing and 1% at monitoring (Summary of Information Submitted to MEDMARX™ in the Year 2000). The current automated systems present more sophisticated advantages, including: lower costs associated with pharmaceutical distribution, reduction of personnel, inventory control, substance control, automated documentation, further reduction of errors, and relieving professional pharmacists and nursing personnel of many tasks.
There are two types of methods and currently two ways of dispensing medications employed in medical facilities: centralized systems, and decentralized systems.
The centralized systems are based on the transfer of the physician's orders/prescription to the central pharmacy of the medical facility. These systems facilitate the transfer of orders/prescriptions to the central pharmacy after being reviewed by personnel in the ward/floor, whereupon the orders/prescriptions are reviewed, authorized and filled by a pharmacist, sent as a unit dose to the ward, where every patient has a personal container, usually at a central location, that contains all his medicine for the next 24 hours, and then dispensed to the appropriate patient according to each individual hospital's routines. Centralized systems are used primarily in the U.S.A. They are costly and very inefficient, mainly because of the use of a large trained staff.
Decentralized systems arc based on ward stocks managed by trained nursing personnel in conjunction with pharmacists from the hospital pharmacy. The dispensing procedure traditionally proceeds as follows:
The nurse receives from the physician the prescription/s stating the medication, time of delivery, and route (p.o., I.V., etc.).
At the appropriate time, the nurse retrieves the appropriate medication/s for the patients according to a list of orders, places the medications into a receptacle, usually with an attachment that indicates the patient's name, places the receptacles on a tray, and then dispenses the receptacles to the patients in the ward.
The foregoing traditional method is subject to a number of disadvantages including: (1) possible confusion between patient files; (2) errors in brand or dosage when retrieving medications from the medicine cabinet; (3) errors in identifying individual patients; (4) errors in receptacle identification; (5) a demand on much of the nurse's time; (6) possibility of mistakes in inventory record keeping and pharmacy ordering; and (7) very low degree of control, even though expensive and/or narcotic drugs are involved.
A report from the Institute of Medicine (IOM) of the National Academies released in November 1999 in the U.S.A. calls on Congress to create a national patient safety center to develop new tools and systems, the reason being alarming figures regarding the human cost of medical errors. Deaths from medical errors are estimated, according to different studies, to be between 44,000 to 98,000 people in the U.S. hospitals each year, which is more than those from highway accidents, breast cancer or AIDS. The report states that illegible handwriting, and the non-coordinated treatment of patients by several practitioners who do not have complete information about the medicines prescribed and the patient's illnesses, are part of the basic flaws in the way the health system is presently organized. William Richardson, chairman of the committee, is quoted as saying “It may be part of human nature to err, but it is also part of human nature to create solutions, find better alternatives, and meet the challenges ahead.”
Medication management devices generally fall under three categories: (a) automated devices in the central pharmacy area; (b) automated devices in the patient care unit; and (c) point-of-care information systems.
The primary goal of using centrally-located devices is to replace or improve the current manual process for filling unit dose containers. These devices offer the advantage of a lower, single, centralized inventory: Disadvantages of such devices include large size, high cost, and reliance on efficient delivery systems from the central pharmacy.
Many systems have been proposed and are described in the literature for minimizing or eliminating the above-described disadvantages of the existing systems. Examples of such recent developments are described in U.S. Pat. Nos. 6,032,155; 6,021,392; 5,912,818; 5,314,243; 5,564,803; 6,003,006; 6,068,156; 5,842,976; 5,797,515; 5,014,875; 5,460,294; and 5,713,485.
However, prior to the present invention there has been a very pressing need to provide a flexible medication dispensing system which utilizes both the centralized and decentralized methods of dispensing medication, and meets at least the following goals: (1) provides secure and reliable medication dispensing; (2) permits more efficient workflow; (3) allows for the collection of vital signs (e.g., temperature, pulse rate and blood pressure); (4) maximizes automation and employs computerized paperless operation; (5) automates management of drug inventory in each department; (6) protects against “drug abuse” by medical and para-medical personnel; and (7) offers special protection for narcotic drugs.